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PERMITTEE NAME /ADDRESS (Include Facility Name /Location if Different) <br />NAME: Moffat County Mining LLC <br />ADDRESS: 29515 Routt CR 27 <br />Oak Creek, CO 80467 -9704 <br />FACILITY: WILLIAMS FORK MINE <br />LOCATION: 1030 CR 107 <br />CRAIG, CO 81626 <br />ATTN: Jerry Nettleton, Supv <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />C00034142 024 -A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY MMIDD/YYYY <br />04/01/2014 06/30/2014 <br />Form Approved <br />OMB No. 2040 -0004 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />Mine Dewatering to Sedimentation Basin Prior to Discha <br />External Outfall <br />No Discharge <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />EX <br />FREQUENCY <br />OF ANALYSIS <br />SAMPLE <br />TYPE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNITS <br />Oil and grease visual <br />840661 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />* * * * ** <br />* * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />PERMIT <br />REQUIREMENT <br />•.'•'• <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />••'••" <br />* "• "• <br />... <br />Twice Per <br />Month <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER l cer ry under penalty of lawthat this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel properly gather antl <br />t <br />valuatethe information submitted, Based on my inquiry of the person or persons who manage the <br />/ J system, or those persons directly responsible for gathering th t rmat on the information submitted is <br />to the best of my knowledge and belief true accurate and complete I am aware that there are <br />V Y o <br />significant penalties for submitting false ' nformbon,' including the poss 'bilityof fine and imprisonment for SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />4,n.Wng violations, AUTHORIZED AGENT <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Oil and grease sample required if visible sheen is observed. Otrly sampling instructions - I.C.12, pg 11. <br />TELEPHONE <br />AREA Code NUMBER M <br />DATE <br />EPA Form 3320 -1 (Rev.01106) Previous editions may be used. 07/10/2013 Page 4 <br />